Question about JET

[Wajeeh Aj]

Hey folks.

A 6-month-old girl is admitted to the pediatric ICU for postoperative care after a complete repair of tetralogy of Fallot. Her hear rate is 225 beats/mln. A narrow complex tachycardla and cannon A waves are seen on the central venous pressure tracing. Which of the following is the most appropriate intenention at this time?
A) Initiate an esmoloi infuslon.
B) Administer adenosine.
C) Prepare for cardioverslon.
D) Cool the patient.
E) Prepare an eplnephrine infusion.

What do you think ? 🤓

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[Osmosis_JonesDO]

Is it B?

 

[royfan]

I think it's D. JET is a junctional rhythm and caused by an irritable focus, so you want to minimize catecholamines, hence not A or E. adenosine also will make it even worse, since adenosine works at the AV node. Cardioversion will also piss off the irritable focus.

 

[dienekes88]

Hey folks.

A 6-month-old girl is admitted to the pediatric ICU for postoperative care after a complete repair of tetralogy of Fallot. Her hear rate is 225 beats/mln. A narrow complex tachycardla and cannon A waves are seen on the central venous pressure tracing. Which of the following is the most appropriate intenention at this time?
A) Initiate an esmoloi infuslon.
B) Administer adenosine.
C) Prepare for cardioverslon.
D) Cool the patient.
E) Prepare an eplnephrine infusion.

What do you think ? 🤓

Paralyze, cool, and use the antiarrhythmic of your choice. Should burn itself out in a day or two.

 

[mytirf]

It is D. But the reasoning by royfan is incorrect

I think it's D. JET is a junctional rhythm and caused by an irritable focus, so you want to minimize catecholamines, hence not A or E. adenosine also will make it even worse, since adenosine works at the AV node. Cardioversion will also piss off the irritable focus.

It is not from an "irritable focus" that would be ectopic atrial tachycardia or EAT. Junctional ectopic tachycardia (JET) is specifically caused by inflammation and swelling in the junction from the AV node into the HIS purkinje system. Adenosine acts on the AV node and therefore will not have any direct effect on JET but is a diagnostic maneuver because it can rule out AVNRT. Also Cardioversion will not "piss off" JET, but rather not have any effect because JET is an automatic tachycardia and not re-entrant.

Finally, dienekes88 is correct that paralysis and cooling is the appropriate initial treatment followed by infusion of an IV antiarrhythmic. The choice of antiarrhythmic is somewhat institution dependent. There have been trials using sotalol, procainamide, and amiodarone that all show some degree of efficacy although the risk for hypotension and complications is highest with amiodarone. An important point is that atrial pacing should also be used to maximize AV synchrony. Happy to answer any further questions. Please PM if you have any.